GIRD

GIRD is a rather meaningless diagnosis for a pitcher.  Glenohumeral internal rotation deficit is present is pretty much every pitcher who has thrown a ball seriously.   It is a diagnosis of range of motion, not a finding of actual trauma.  Find an ortho who specializes in treating overhand athletes and shoulders in particular.  Your average ortho that sets broken bones from playground injuries is not going to have the experience or expertise to treat a throwing shoulder.

My kid's elbow fracture is related to GIRD. He is about to start PT on it as well as dealing with very tight traps that is also contributing to torquing his elbow. This is the ortho's Dx, he is a solid guy trained at Andrew's facility.

My son struggled with intermittent shoulder pain for a couple years in HS.  He was diagnosed a various times with bicep tendonitis and impingement.  He was told flexibility (GIRD) was a root cause.  He saw multiple orthos and physical therapists and was pretty religious about stretching but it would still flair up from time-to-time.

I am not a doctor but the approach we took was to NOT take any Advil or Aleve.  I wanted him to feel the symptoms and stop throwing if his shoulder was tight.  I don't think taking cortisone or prednisone would be a good idea because it could mask pain and lead to causing injury - just my opinion.

He got through it by finding a really good PT who understood shoulder physiology and regained the flexibility he needed.  I should add that both his HS and travel coaches were fully aware and always took him out when he told them he felt pain.  He now stretches regularly and added hanging to his regiment and hasn't had a problem in a couple years.

I think it's really important to stress finding a physician with a direct, regular practice of treating overhead throwing athletes.  

Smitty how long would the bouts with GIRD last? in other words if it flared up, would he miss a few days? weeks? This has been going on since July but the only thing that gave him temporary relief was a cortisone injection that lasted appx 2 months...he just started a medrol pack yesterday and was told to do a ton of sleeper stretches

the doctors hes been seeing seem qualified, ie doctors for the Olympic team, the local D1 Universities sports team as well as the local AAA baseball team...when I call a dr office should I specifically ask for a dr. that specializes in overhand sports and/or baseball? I think if I asked that they'd all say yes....

@edcoach posted:

Smitty how long would the bouts with GIRD last? in other words if it flared up, would he miss a few days? weeks? This has been going on since July but the only thing that gave him temporary relief was a cortisone injection that lasted appx 2 months...he just started a medrol pack yesterday and was told to do a ton of sleeper stretches

I can’t stress this enough.  GIRD does not “flair up”. Your son’s shoulder pain is not GIRD.  GIRD is an adaptation of the shoulder range of motion.  As you increase your shoulder external range of motion, the layback throwers get when they throw, you lose internal rotation range of motion.  Here is an illustration that compares a typical thrower’s off hand and dominant hand.  Both arms have 180’ range of motion yet the throwing hand has greater ER and “deficit” of  IR.

I would encourage you to read Mike Reinold’s article to understand what a diagnosis of GIRD means.

https://mikereinold.com/gird-g...al-rotation-deficit/

@edcoach posted:

the doctors hes been seeing seem qualified, ie doctors for the Olympic team, the local D1 Universities sports team as well as the local AAA baseball team...when I call a dr office should I specifically ask for a dr. that specializes in overhand sports and/or baseball? I think if I asked that they'd all say yes....

A quick google search found this guy in Oklahoma City:

Dr. Jimmy Conway is a leading expert in the treatment of throwing injuries for baseball and softball players.

http://jimmyconwaymd.com/staff/

A doctor’s bio is easy to find online.  They should list shoulders as a specialty or better if they mention a particular interest in throwing athletes.

thanks 22and25 I just called his office and he has an appointment there in the morning!

Just to be clear, I know nothing about this particular doctor and I am not endorsing him in any way.  He was just an example of the ease with which you can find a shoulder specialist in your area who has an interest in baseball injuries.  

Please read the GIRD article I posted and go armed with good questions.  Being your own best advocate is important with any medical issue.  

I know you werent endorsing but ive never seen a dr around here specifically advertising specialty in baseball/throwing injuries...before this I also made an appoinment at a place called ortho plus

edcoach - glad to see you getting aggressive with this and contacting a specialist.  My son suffered from this (looking at 22and25s diagram) and missed his whole junior season.....it was all about flexibility and range of motion on his pitching side.   He was supposed to start against UNC in the NCAA regionals in 2012.  It got to be so bad that he only pitched part of an inning in relief in the NCAA regional pool play....they had to shut him down immediately.

Prior too this episode, my wife and I knew nothing about it...he never complained.   He was absolutely devastated at how his season ended.  He worked his way back his senior year.   This isn't something to mess around with.

Good luck!

PS....great stuff 22and25

thanks fenwaysouth....im sorry about your son but glad he made it back....im definitely at my wits end and definitely not messing around...hopefully tomorrow answers are gained...its been almost 7 months..one common denominator so far is all 3 orthos have said no surgery required so I guess thats good...I think many may push surgeries but not so far.

I would second the Reinold recommended read.  I've found Mike (and his partner Lenny) to be a good resource, and a very good guy.

@Smitty28 posted:

My son struggled with intermittent shoulder pain for a couple years in HS.  He was diagnosed a various times with bicep tendonitis and impingement.  He was told flexibility (GIRD) was a root cause.  He saw multiple orthos and physical therapists and was pretty religious about stretching but it would still flair up from time-to-time.

I am not a doctor but the approach we took was to NOT take any Advil or Aleve.  I wanted him to feel the symptoms and stop throwing if his shoulder was tight.  I don't think taking cortisone or prednisone would be a good idea because it could mask pain and lead to causing injury - just my opinion.

He got through it by finding a really good PT who understood shoulder physiology and regained the flexibility he needed.  I should add that both his HS and travel coaches were fully aware and always took him out when he told them he felt pain.  He now stretches regularly and added hanging to his regiment and hasn't had a problem in a couple years.

Excellent point about hanging (from a bar, a door or whatever). It is a must for keeping bicep muscles elongated and not near enough emphasis is put on it IMO.

@Fenwaysouth, I am not sure if you read the linked article but the point is that the pitcher in that diagram is not suffering from anything.  The problem with many GIRD diagnosis is this:

Pitcher presents to ortho with “shoulder pain”.

Ortho compares internal rotation of throwing shoulder and non throwing shoulder.  Notes IR deficit in throwing shoulder and declares a finding of GIRD.

Player with hurt shoulder reports to PT with prescription for stretching to correct GIRD.

Did the ortho compare external rotation?  Note a loss of total range of motion when adding ER and IR as compared to the non throwing shoulder?

In actuality, shoulder pain is likely caused by something completely unrelated to the loss of internal rotation.

ive literally gone from never hearing the word GIRD 24 hrs ago to knowing way more than I need to :-)     Im thinking my son's injury isnt GIRD for one because it happened (popped) on a long throw from the outfield.  I do agree he hasnt stretched appropriately or thoroughly before games for years...but GIRD seems to be incorrect...he swears the pain is when he ER's the shoulder not the IR

@edcoach posted:

Smitty how long would the bouts with GIRD last? in other words if it flared up, would he miss a few days? weeks? This has been going on since July but the only thing that gave him temporary relief was a cortisone injection that lasted appx 2 months...he just started a medrol pack yesterday and was told to do a ton of sleeper stretches

He would have to take it easy for a couple days then ease back into throwing, so he might have to DH or play OF for a game or two before going back behind the plate during HS season.  In the summer he had to skip a tournament a few times. He could go months with no pain and the BAM it flared up again.  It was always scary and I was convinced he must have a tear or something, but it always went away.  One piece of info we got from a very experienced ortho surgeon was that if he could throw at all without pain it's not a tear.

@adbono posted:

Excellent point about hanging (from a bar, a door or whatever). It is a must for keeping bicep muscles elongated and not near enough emphasis is put on it IMO.

No doctor, physical therapist, coach, trainer or anyone ever mentioned this.  He picked it up from an Instagram post by Michael Lorenzen.